Disaster nursing (part 1)

A disaster is a sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.

1. DISASTER

2. INTRODUCTION The word derives from Greek pejorative prefix dus = "bad" + aster = "star". The root of the word disaster ("bad star" in Greek) comes from an astrological theme in which the ancients used to refer to the destruction or deconstruction of a star as a disaster. The ancient people believed that the disaster is occurred due to the unfavorable position of the “planets” or “Act of God”. Gradually they understand the mysteries of nature.

3. DISASTER D -detection I - incident S - safety & security A - assess hazards S - support T - triage & treatment E – evacuation R - recovery

4. Definition 4 Disaster – Any occurrence that causes damage , ecological disruption, loss of human life,deterioration of health and health services on a scale, sufficient to warrant an extraordinary response from outside the affected community or area . ( WHO) A disaster can be defined as an occurrence either nature or man made that causes human suffering and creates human needs that victim cannot alleviate without assistance . ( American Red Cross)

5. HAZARD

6. Disasters occur in varied forms Some are predictable in advance Some are annual or seasonal Some are sudden and unpredictable Floods E arth q ua k es Cyclones Droughts Days and weeks Se c o n ds / minu t es Days Months

7. Disaster nursing Disaster nursing can be defined as ''a adaptation of professional nursing skills in recognizing and meeting the nursing physical and emotional needs resulting from the disaster.''

8. C l a s s i f i c a t i o n o f D i s a s t e r s 8 Natural Dis a s t e r s Meteorologic a l T o p o g r a p h i c al En v iro n mental Man made Disasters T e c hnological Industrial W arfare

9. Met eoro l og i cal Disasters Floods Tsunami Cyclone Hurricane Typhoon Snow storm Blizzard Hail storm T op o graph i cal Disasters Earthquake Volcanic Erupti o ns Landslides and A va l anc h es E n vironmental Disasters Global w a r m i n g Ozone d e p l eti o n - UVB Radiation Solar flare 9

10. T ec h nologi c al T rans p ort failure Public place failure Fire Ind u strial Ch e mical spills R a dio a ctive spills W arfare 10 War Terrorism Internal c o nflicts Civil unrest CBRNE

11. TYPES OF DISASTER Natural Disaster – tornados, hailstorms, tsunami, floods, Earthquakes, communicable disease etc . Man-Made Disaster- fires, explosions, toxic materials, pollution, terrorist attack, transportation accidents etc .

12. DISASTER dimensions Disruption to normal pattern of life , usually severe and may also be sudden, unexpected and widespread Human effects like loss of life, injury, hardship and adverse effect on health such as – Ef f e c t o n s oc i al infrastruc t ure destruction of or damage to go v e r nm e nt s y s t e m s , build i ng s , c o mm u ni c a t io n s a n d essential services – C o m m un i t y ne e ds su c h she l t e r , food, clothing, medical assistance and social care.

13. Goals of the Disaster Nursing To meet the immediate basic survival needs of populations affected by disasters. T o id en t i f y t h e p ot en t i a l f o r a seco n da ry disaster. T o app r a i s e bo t h ri sk s an d r eso ur ce s i n the environment. To correct inequalities in access to health care or appropriate resources.

14. Contd.. To empower survivors to participate in and advocate for their own health and well being. To respect cultural, lingual, and religious diversity in individuals and families and to apply this principle in all health promotion activities. To promote the highest achievable quality of life for survivors.

15. PRINCIPLES OF DISASTER Minimize the casualties. Prevent further casualties. Rescue the victims. First aid. Medical care. Reconstruction. Disaster management is the responsibility of all spheres of govt. Disaster management should use resources that exist for a day-to-day purpose.

16. Principles of Disaster Nursing Rapid assessment of the situation and of nursing care needs. Triage and initiation of life-saving measures first. The selected use of essential nursing interventions and the elimination of nonessential nursing activities.

17. Contd.. E v a l u ati o n o f t he en v ir o n m en t a n d the mitigation or removal of any health hazards. Prevention of further injury or illness. Le a de r s hi p i n coo r d i na t i n g pa t i en t t r i ag e, care, and transport during times of crisis.

18. Contd.. T h e t each i ng , supe r vi s i on , a n d u tiliz a tio n of auxiliary medical personnel and volunteers. Provision of understanding, compassion and emotional support to all victims and their families.

19. Health Effects of Disasters Disasters may cause premature deaths, illnesses, and injuries. Di s a s t e rs m a y d e s tr oy t he l oca l h ea l t h ca r e infrastructure. Di s a s t e rs m a y a ff e c t t he p s y ch ol og ic a l , e m o tio n a l, and social well being of the population.

20. Contd… Di s a s t e rs m a y ca use sh o r t ag e s o f f oo d an d c au se severe nutritional deficiencies. Disasters may create large population movements. Disasters may create environmental imbalances.

21. CHARACTERISTIC OF DISASTER

22. Phases of a Disaster Pre-impact phase Impact phase Post-impact phase

23. PRE-IMPACT PHASE It is the initial phase of disaster, prior to the actual occurrence. A warning is given at the sign of the first possible danger to a community with the aid of weather networks and satellite many meteorological disasters can be predicted. The role of the nurse during this warning phase is to assist in preparing shelters and emergency aid stations and establishing contact with other emergency service group.

24. IMPACT PHASE The impact phase occurs when the disaster actually happens. It is a time of enduring hardship or injury end of trying to survive. This is the time when the emergency operation center is established and put in operation. It serves as the center for communication and other government agencies of health tears care healthcare providers to staff shelters. Every shelter has a nurse as a member of disaster action team. The nurse is responsible for psychological support to victims in the shelter.

25. POST – IMPACT PHASE Recovery begins during the emergency phase ends with the return of normal community order and functioning. The victims of disaster in go through four stages of emotional response. 1. Denial – during the stage the victims may deny the magnitude of the problem or have not fully registered. 2. Strong Emotional Response – in the second stage, the person is aware of the problem but regards it as overwhelming and unbearable.

26. Contd.. Acceptance – During the third stage, the victim begins to accept the problems caused by the disaster and makes a concentrated effect to solve them. Recovery – The fourth stage represent a recovery from the crisis reaction. Victims feel that they are back to normal.

27. DISASTER MANAGMENT

28. A CONTINUOUS AND INTEGRATED PROCESS OF PLANNING, ORGANISING, COORDINATING AND IMPLEMENTING MEASURES WHICH ARE NECESSARY OR EXPEDIENT FOR: i ) Prevention of danger or threat of any disaster. Mitigation or reduction of risk of any disaster or its severity or consequences . Capacity-building . Preparedness to deal with any disaster; Prompt response to any threatening disaster situation or disaster . Assessing the severity or magnitude of effects of any disaster; evacuation, rescue and relief . Rehabilitation and reconstruction . (Disaster Management Act, 2005)

29. Prevention Mitigation Preparedness Response Rehabilitation Reconstruction Six elements that defines the complete approach to Disaster Management.

30. DISASTER MANAGEMENT CYCLE

31. Wha t i s Disaste r Management

32. Integrated Disaster Management Prepared- ness Response Recovery Mitigation Activities prior to a disaste Preparedness plans Emergency exercises Training, Warning systems Activities that reduce effects of disasters Building codes & zoning Vulnerability analyses Public education Activities following a disaster . Temporary housing Claims processing Grants Medical care Activities during a disaster. Public warning systems Emergency operations Search & rescue

33. Disaster preparedness Preparedness should be in the form of money, m a npo w er a nd mater i als 🞇 E v al u a t io n from pas t ex p er i ences abou t r i sk 🞇 Lo c at i on of d i s a st e r pr o ne areas 🞇 Organization of communication, information an d warn i ng system 🞇 Ens u r i ng co - ord i na t i on an d response mechanisms

34. 🞇 De v elop ment of p ubl i c educat i on programme 🞇 Co - ord i na t i on w i th med i a 🞇 Nat i on a l & i nternat i on a l relat i ons 🞇 Kee p i ng st o ck of foods, drug an d other es s ent i al commod i t i es. Cont d ….

35. Disaster impact

36. Rehabilitation phase 🞇 W at e r s u p p ly 🞇 Food safety 🞇 B a s i c s a n i t a t i on a nd person a l h y g i ene 🞇 Vector control

37. Dis a st e r mi t iga t ion 🞇 This involves lessening the likely effects of emergencies. 🞇 T h e s e i n c l ude dep e n d i n g u pon t h e d i s a s t e r, pr o t e c t i on of v u l n e r a b l e p o p u l a ti on a n d s t ruc t ure. Eg. improving structural qualities of schools, houses and such other buildings so that medical causalities can be minimized. 🞇 Similarly ensuring the safety of health facilities and public health services including water supply and sewerage system to reduce the co s t of r e h a b i l it a ti on an d r e con s t ruc t i o n . This mitigation compliments the disaster preparedness and disaster r e s p o n s e a c t i v i ti e s .

38. DISASTER-EFFECTS 🞇 Deaths 🞇 Disability 🞇 I ncr ea s e i n commu n i cable d i se a se 🞇 Psy c holog i cal pr o blems 🞇 Food shortag e 🞇 Soc i oeconom i c los s es 🞇 Shortage of d r ugs a nd med i cal s u p p l i es. 🞇 Environmental disruption

39. DISASTE R RECOVERY 🞇 S u c c es s fu l Re c o v ery P r eparat ion 🞇 B e v i g il a nt i n Health teach i ng 🞇 Psy c holog i cal s u p p ort 🞇 Refer ral s to hosp i tal a s needed 🞇 Remain alert for environmental health 🞇 Nurse m u s t be a tten t i v e to the danger

40. E.g.: Indian Meteorological department (IMD) plays a key role in forewarning the disaster of cyclone-storms by detection tracing. It has 5 centres in Kolkata, Bhubaneswar, Vishakapatanam, Chennai & Mumbai. In addition there are 31 special observation posts setup a long t he east coas t of I ndia. The International Agencies which provides humanitarian assistance to the di s a s t e r s t ri k e area s a re U nit e d N a t i on ag e ncies. Office for the co-ordination of Humanitarian Affair (OCHA) W or l d Hea l t h O r g an i z a t i on ( W H O ) UNICEF W or l d F ood Prog r a m me ( W F P ) Food & Agricultural Organisation (FAD ) E.g.: Non Governmental Organizations 🞇 Co-Operative American Relief Every where (CARE) 🞇 I n t e rnat i onal commi tt e e of R e d cross 🞇 I n t e rnat i onal commi tt e e of R e d cross

41. TRIAGE

42. Derived from a French word ‘triar’ which means ‘to separate out’ A method of quickly identifying victims who have immediately life-threatening injuries and who have the best chance of surviving Use when the quantity severity of injuries overwhelm the operative capacity of health facilities .

43. The principal of “first come” “first treat” is not followed in mass emergencies Processing of determining the priorities patients treatment based on their severity It consist of rapidly classifying the patients as per the severities as High priorities Low priorities

44. The goal of managing a mass casualty incident Priorities for transportation to the hospital Priorities for care in the field

45. ADVANCED TRIAGE CATEGORIES CLASS I (EMERGENT) RED IMMEDIATE – Victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care. – They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced facilities; they “cannot wait” but are likely to survive with immediate treatment. “Critical; life threatening—compromised airway, shock, hemorrhage” CLASS II (URGENT) YELLOW DELAYED – Victims who are seriously injured and whose life is not immediately threatened; and can delay transport and treatment for 2 hours. – Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under “normal” circumstances). “Major illness or injury;—open fracture, chest wound” CLASS III (NON-URGENT) GREEN MINIMAL – “Walking wounded,” the casualty requires medical attention when all higher priority patients have been evacuated, and may not require monitoring. – Patients/victims whose care and transport may be delayed 2 hours or more. “minor injuries; walking wounded—closed fracture, sprain, strain” CLASS IV (EXPECTANT) BLACK EXPECTANT They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock, severe head or chest wounds); They should be taken to a holding area and given painkillers as required to reduce suffering. “Dead or expected to die—massive head injury, extensive full-thickness burns”

46. Created in the 1980’s by Hoag Hospital and the Newport Beach CA Fire Dept Allows rapid assessment of victims It should not take more than 15 sec/ Pt Once victim is in treatment area more detailed assessment should be made Clasificación is based on three items Respiratory Perfusion ( bld loos ) Mental status evaluation ( neuro )

47. Organizing an effective Disaster System The nurse must be familiar with the personnel at the disaster scene and their roles and functions. A disaster scene is usually broken up into three zones-

48. Contd .. Disaster zone Treatment zone Transport zone

49. 1.Disaster zone : It is the actual location of the incident from where patient are to be removed as soon as possible. Majority of disaster personnel are sent to this zone initially .

50. 2.Treatment zone: Nurses spend most of their time in their zone during a disaster, where equipment and personnel to carry out patient care are concentrated. Activities carried out in this zone includes. Assessment of each patient Treatment of injuries Preparation for transport .

51. 3.Transportation zone : It should be situated directly next to the treatment zone so that ambulances and other vehicles can load patient and leave for hospitals. delivering appropriate patient care:

52. Triage area must be equipped with the following Wheelchairs Stretchers Backboards IV poles Splints, bandages Emesis basins Disaster tags Pens Adhesive tape Oral airway Scissors Blankets Stethoscope Emergency trolley with equipment

53. MAJOR ROLES OF NURSE IN DISASTER Define health needs of the affected groups Establish priorities and objectives Identify actual and potential public health problems

54. C o n t d .. Determine resources needed to respond to the needs identified Collaborate with other professional disciplines, governmental and non-governmental agencies Maintain a unified chain of command

55. CONCLUSION Hardly a day now passes without news about a major or complex emergency happening in some part of the world. Disasters continue to strike and cause destruction in developing and developed countries about their vulnerability to occurrences that can gravely affect their day to day life and their future. Nurses in any location will be on the frontline as care giver and managers in the event of damaging disaster.

56. Contd . . So they need to have adequate knowledge and framing to work in such a unique, chaotic stressful situations and to identify and meet the complex, multifarious health needs of victims of disaster.

57. SUMMARY/EVALUATION Define the term Disaster and Disaster Nursing. Explain the type of disaster. Enlist the goals of disaster nursing. List down the principles of disaster nursing. Explain about phases of disaster. Explain disaster Management cycle and how to organize an effective disaster system Discuss about major roles of nurse in disaster.